by Phil Emberley BSc. (Pharm)
Recovery Ottawa is a specialized medical practice that is focused on the treatment of addiction and other mental health disorders. The practice employs three main addiction specialists, as well as several others who attend around once a week. Respect Rx is adjoined to the medical practice and is primarily a dispensary with minimal front store merchandise.
Most of the clients that we see are considered marginalized, either homeless, living in shelters, or substandard housing. The prevalence of comorbid mental health issues such as depression, anxiety and schizophrenia is high within our patient population. As such, our clients are quite fragile, and the psychological and physical toll of this pandemic could be catastrophic.
In mid-January, COVID-19 was a far-off disaster which many mistakenly assumed would never reach North America. However, in recent weeks, it has become obvious that this was not the case.
The nature of this clinic, and our pharmacy, has led to several unique challenges. Among the most significant is the way in which treatment occurs within the clinic. Most clients being treated for addiction show up once a week for urine screening and for a physician visit, and then show up daily for their opioid agonist therapy. Once a client is well into the program, they may receive one or more days’ worth of medication (i.e. “carries”) but for many, daily dosing is the norm. Also, the clinic and pharmacy share a common area, and it is not uncommon for 20 or more clients to occupy this area while they wait for their doctor’s appointment or medication.
It became apparent that this practice model could not be sustained once physical distancing became a necessity to slow the spread of SARS-CoV2. On a case by case basis, clients were re-evaluated and where appropriate, clients were given carries so they did not have to show up daily.
A few weeks ago, seating areas within the practice were removed, and controlled entry was initiated in an effort to promote appropriate distancing. Further, in the pharmacy, plexiglass was installed at the patient service areas to protect both clients and staff. There is now a barrier between the medical practice common area and the pharmacy waiting area to avoid having clients congregate. Needless to say, cleaning protocols have also been enhanced.
Respect Rx also provides Dispill packaged medications to a large number of clients living in shelters and group homes. These homes are particularly vulnerable to a deadly outbreak, and our deliveries to these homes have been modified so that our drivers drop off only at their entrance.
Needless to say, there is a lot of anxiety and palpable fear, both amongst clients and staff. Anxiety often presents in patients with depression, and it’s quite evident that many of our clients are struggling. We fear that many lack the strong immune system to fight COVID-19, and with many already having respiratory or cardiovascular disease, they are considered high risk. With respect being a foundational principle of the pharmacy in an effort to destigmatize those with addictions and mental health issues, our role as healthcare providers has recently evolved to trying to allay our clients’ fears and promote healthy practices to protect them from infection. However, this is much more challenging in a patient population already living on the edge and without many of the living standards that many of us take for granted.
Phil Emberley BSc. (Pharm) is a community pharmacist with over 30 years of experience as a pharmacist, having worked in community practice, government and for the Canadian Pharmacists Association. He is currently clinical lead at Respect Rx Pharmacy, a specialty pharmacy focused on mental health and addictions.